A conjoint experiment of three placebo rectal products used with receptive anal sex: results from MTN‐035

Author:

Bauermeister José1ORCID,Lin Willey1,Tingler Ryan1,Liu Albert2ORCID,Chariyalertsak Suwat3,Hoesley Craig4,Gonzales Pedro5,Ho Ken6,Kayange Noel7,Phillips Thesla Palanee8ORCID,Johnson Sherri9,Brown Elizabeth10ORCID,Zemanek Jillian10,Jacobson Cindy E.9,Doncel Gustavo F.11,Piper Jeanna12,

Affiliation:

1. University of Pennsylvania Philadelphia Pennsylvania USA

2. Bridge HIV at the San Francisco Department of Public Health San Francisco California USA

3. Research Institute for Health Sciences, Chiang Mai University Chiang Mai Thailand

4. University of Alabama at Birmingham Birmingham Alabama USA

5. IMPACTA, Asociación Civil Impacta Salud y Educación, San Miguel CRS Lima Perú

6. University of Pittsburgh Pittsburgh Pennsylvania USA

7. Blantyre CRS, Johns Hopkins University Research Project Blantyre Malawi

8. Wits Reproductive Health and HIV Institute Johannesburg South Africa

9. FHI 360 Durham North Carolina USA

10. Statistical Center for HIV/AIDS Research & Prevention, Fred Hutchinson Cancer Research Center Seattle Washington USA

11. CONRAD, Eastern Virginia Medical School Norfolk Virginia USA

12. Division of AIDS United States National Institute of Health, National Institute of Allergy and Infectious Diseases Bethesda Maryland USA

Abstract

AbstractIntroductionEnd‐user perspectives are vital to the design of new biomedical HIV prevention products. Conjoint analysis can support the integration of end‐user perspectives by examining their preferences of potential pre‐exposure prophylaxis (PrEP) products. The Microbicides Trial Network (MTN) 035 protocol examined three placebo rectal dosage forms (insert, enema and suppository) that could deliver PrEP prior to receptive anal sex (RAS).MethodsBetween April 2019 and July 2020, we enrolled 217 HIV‐negative, cisgender men who have sex with men (MSM; n = 172; 79.3%) and transgender people (n = 47; 20.7%) ages 18–35 into a randomized cross‐over trial across Malawi, Peru, South Africa, Thailand and the United States. Participants used each product prior to RAS over 4‐week periods. Participants completed a conjoint experiment where they selected between random profiles using seven features (dosage form, timing of use before sex, side effects, duration of protection, effectiveness, frequency of use and need for a prescription).ResultsEffectiveness was the strongest determinant of choice (30.4%), followed by modality (18.0%), potential side effects (17.2%), frequency of use (10.8%), duration of protection (10.4%), timing of use before sex (7.4%) and need for a prescription (5.9%). Relative utility scores indicated that the most desirable combination of attributes was a product with 95% efficacy, used 30 minutes before sex, offering a 3‐ to 5‐day protection window, used weekly, having no side effects, in the form of an enema and available over‐the‐counter.ConclusionsChoice in next‐generation PrEP products is highly desired by MSM and transgender people, as no one‐size‐fits‐all approach satisfies all the preferences. MTN‐035 participants weighed product features differently, recognizing the need for diverse, behaviourally congruent biomedical options that fit the needs of intended end‐users.

Funder

National Institute of Allergy and Infectious Diseases

National Institute of Child Health and Human Development

National Institute of Mental Health

National Institutes of Health

United States Agency for International Development

Publisher

Wiley

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